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General NPI Number Information
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NPI Number | 1124594155
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Entity Type | Individual
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Provider Name | MONIQUE YVETTE GRAHAM CASAC-T
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Gender | Female
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 10/17/2018
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Provider Practice Location Address
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Address Line | 50 W HAWTHORNE AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-6220
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Country | US
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Telephone | 516-872-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 183 LAUREL ST
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-1322
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Country | US
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Telephone | 516-669-4035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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